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__NOTOC__ | __NOTOC__ | ||
{{Pancoast tumor}} | {{Pancoast tumor}} | ||
{{CMG}}{{AE}}{{Mazia}} | {{CMG}}; {{AE}} {{Mazia}} | ||
==Overview== | |||
The [[patient]] experiences non-specific [[symptoms]] such as [[cough]], [[hemoptysis]], [[dyspnea]], [[chest pain]], [[dysphonia]], [[dysphagia]], lack of [[appetite]], [[weight loss]], and [[fatigue]] from 3 weeks to 3 months before seeking medical attention. Without treatment, the [[patient]] will develop initial [[symptoms]] of [[cough]] and [[chest pain]], which may eventually lead to [[Pancoast's syndrome]]. The [[symptoms]] of [[Pancoast's syndrome]] start as [[referred pain]] to the [[shoulder]]. Without treatment, the [[tumor]] may invade surrounding [[tissues]] to cause [[pain]] along the [[ulnar nerve]] distribution, [[atrophy]] of [[Hand|hand muscles]] and [[spinal cord compression]]. The [[complications]] associated with Pancoast tumor are [[breathing difficulties]], [[pneumonia]], [[hemoptysis]], [[pain]], [[pleural effusion]],[[metastasis]], [[Horner's syndrome]], [[superior vena cava syndrome]], [[Spinal cord compression|compression of the spinal cord]], and [[paraplegia]] ([[paralysis]] of the lower half of the [[body]] with involvement of both [[legs]]) develop when the [[tumor]] extends into the [[intervertebral foramina]] (opening between two [[vertebrae]]). The [[prognosis]] of Pancoast tumor depends on the stage of the [[tumor]] at [[diagnosis]]. The factors associated with a poor [[prognosis]] among [[patients]] with Pancoast tumor include [[Horner's syndrome]], spread to the [[mediastinal]] [[lymph nodes]], incomplete [[resection]] of [[tumor]], involvement of [[Supraclavicular lymph nodes|supraclavicular lymph node]], [[vertebral body]] [[invasion]], [[metastasis]] to the [[brain]]. | |||
==Natural History== | ==Natural History== | ||
*The patient experiences non-specific symptoms such as [[cough]], [[hemoptysis]], [[dyspnea]], [[chest pain]], [[dysphonia]], [[dysphagia]], lack of appetite, [[weight loss]], and [[fatigue]] from 3 weeks to 3 months before seeking medical attention. | *The [[patient]] experiences non-specific [[symptoms]] such as [[cough]], [[hemoptysis]], [[dyspnea]], [[chest pain]], [[dysphonia]], [[dysphagia]], lack of [[appetite]], [[weight loss]], and [[fatigue]] from 3 weeks to 3 months before seeking [[medical]] attention.<ref name="pmid23702478">{{cite journal |vauthors=Glassman LR, Hyman K |title=Pancoast tumor: a modern perspective on an old problem |journal=Curr Opin Pulm Med |volume=19 |issue=4 |pages=340–3 |date=July 2013 |pmid=23702478 |doi=10.1097/MCP.0b013e3283621b31 |url= |author=}}</ref><ref name="pmid24672686">{{cite journal |vauthors=Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D |title=Pancoast tumors: characteristics and preoperative assessment |journal=J Thorac Dis |volume=6 Suppl 1 |issue= |pages=S108–15 |date=March 2014 |pmid=24672686 |pmc=3966151 |doi=10.3978/j.issn.2072-1439.2013.12.29 |url= |author=}}</ref><ref name="pmid10813231">{{cite journal |vauthors=Jones DR, Detterbeck FC |title=Pancoast tumors of the lung |journal=Curr Opin Pulm Med |volume=4 |issue=4 |pages=191–7 |date=July 1998 |pmid=10813231 |doi= |url= |author=}}</ref> | ||
*Without treatment, the patient will develop initial symptoms of cough and chest pain, which may eventually lead to Pancoast syndrome. | *Without treatment, the [[patient]] will develop initial [[symptoms]] of [[cough]] and [[chest pain]], which may eventually lead to [[Pancoast's syndrome]]. | ||
*The symptoms of Pancoast syndrome start as referred pain to the shoulder. Without treatment, the tumor may invade surrounding tissues to cause pain along the ulnar nerve distribution, atrophy of hand muscles and spinal cord compression. | *The [[symptoms]] of [[Pancoast's syndrome]] start as [[referred pain]] to the [[shoulder]]. Without [[Treatments|treatment]], the [[tumor]] may invade surrounding [[tissues]] to cause [[pain]] along the [[Ulnar nerve|ulnar nerve distribution]], [[atrophy]] of [[hand]] [[muscles]], and [[Spinal cord compression|spinal cord compression.]] | ||
==Complications== | ==Complications== | ||
Pancoast tumor is a subtype of lung cancer that is located at the apex of the lung. | Pancoast tumor is a subtype of [[lung cancer]] that is located at the [[apex]] of the [[lung]].The [[complications]] associated with Pancoast tumor are:<ref name="pmid23702478" /><ref name="pmid24672686">{{cite journal |vauthors=Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D |title=Pancoast tumors: characteristics and preoperative assessment |journal=J Thorac Dis |volume=6 Suppl 1 |issue= |pages=S108–15 |date=March 2014 |pmid=24672686 |pmc=3966151 |doi=10.3978/j.issn.2072-1439.2013.12.29 |url= |author=}}</ref><ref name="pmid10813231">{{cite journal |vauthors=Jones DR, Detterbeck FC |title=Pancoast tumors of the lung |journal=Curr Opin Pulm Med |volume=4 |issue=4 |pages=191–7 |date=July 1998 |pmid=10813231 |doi= |url= |author=}}</ref><ref name="Jones">{{cite journal | last =Jones | first =DR | coauthors =Detterbeck FC | title =Pancoast tumors of the lung | journal =Current Opinion in Pulmonary Medicine | volume =4 | issue =4 | pages =191–197 | date =Jul 1998 | pmid =10813231 }}</ref><ref name="pmid16476534">{{cite journal |vauthors=Eren S, Karaman A, Okur A |title=The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT |journal=Eur J Radiol |volume=59 |issue=1 |pages=93–103 |year=2006 |pmid=16476534 |doi=10.1016/j.ejrad.2006.01.003 |url=}}</ref> | ||
The complications associated with Pancoast tumor are: | |||
* [[Breathing difficulties]] | * [[Breathing difficulties]] | ||
:* Lung cancer patients can experience trouble breathing especially when [[tumors]] grow and block the airways. Also, it is possible for fluid to build up in the lungs of the patients which makes it difficult for the lungs to fully expand when [[inhaling]]. | :* [[Lung cancer]] [[patients]] can experience trouble [[breathing]] especially when [[tumors]] grow and block the [[airways]]. Also, it is possible for fluid to build up in the [[lungs]] of the [[patients]] which makes it difficult for the [[lungs]] to fully expand when [[inhaling]]. | ||
* [[Pneumonia]] | * [[Pneumonia]] | ||
:* If cancer grows in the [[airway]], it may obstruct airflow, causing [[dyspnea|breathing difficulties]]. This can lead to accumulation of secretions behind the blockage, predisposing the patient to [[pneumonia]]. | :* If [[cancer]] grows in the [[airway]], it may obstruct airflow, causing [[dyspnea|breathing difficulties]]. This can lead to accumulation of [[secretions]] behind the blockage, predisposing the [[patient]] to [[pneumonia]]. | ||
* [[Hemoptysis]] (coughing up blood) | * [[Hemoptysis]] ([[coughing up blood]]) | ||
:* Occasionally lung cancer can cause bleeding in the airways which results in the patient coughing up [[blood]]. | :* Occasionally [[lung cancer]] can cause [[bleeding]] in the [[airways]] which results in the [[patient]] [[coughing]] up [[blood]]. | ||
* [[Pain]] | * [[Pain]] | ||
:* It is possible that Pancoast tumor will cause shoulder pain as well, especially if it spreads to the surrounding tissue resulting in Pancoast syndrome. | :* It is possible that Pancoast tumor will cause [[shoulder pain]] as well, especially if it spreads to the surrounding [[tissue]] resulting in [[Pancoast's syndrome]]. | ||
* [[Pleural effusion]] | * [[Pleural effusion]] | ||
:* Lung cancer can cause fluid to build up in the lungs which can cause breathing difficulties. | :* [[Lung cancer]] can cause fluid to build up in the [[lungs]] which can cause [[breathing difficulties]]. | ||
* [[Metastasis]] | * [[Metastasis]] | ||
:* In many cases, lung cancer will spread out to other parts of the body. Some of the more common places lung cancer metastasizes to are the [[bones]], [[liver]], [[brain]], and [[adrenal glands]]. | :* In many cases, [[lung cancer]] will spread out to other parts of the [[body]]. Some of the more common places [[lung cancer]] [[Metastasize|metastasizes]] to are the [[bones]], [[liver]], [[brain]], and [[adrenal glands]]. | ||
* [[Horner's syndrome]] | * [[Horner's syndrome]] | ||
:* Tumors in the | :* [[Tumors]] in the [[apex]] of the [[lung]], known as [[Pancoast tumor]]s, may invade the local part of the [[sympathetic nervous system]], leading to changed [[sweating]] patterns and [[Eye muscles|eye muscle]] problems (a combination known as [[Horner's syndrome]]). | ||
*[[Superior vena cava syndrome]] | *[[Superior vena cava syndrome]] | ||
**SVCS is a group of symptoms caused by obstruction of the superior vena cava. More than 60% of cases of superior vena cava obstruction are caused by malignant causes, typically a tumor outside the vessel compressing the vessel wall. | **[[Superior vena cava syndrome|SVCS]] is a group of [[symptoms]] caused by [[obstruction]] of the [[superior vena cava]]. More than 60% of cases of [[Superior vena cava syndrome|superior vena cava obstruction]] are caused by [[malignant]] [[causes]], typically a [[tumor]] outside the [[vessel]] compressing the [[vessel]] wall. | ||
*[[Spinal cord compression|Compression of the spinal cord]] | *[[Spinal cord compression|Compression of the spinal cord]] | ||
**Spinal cord compression and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between two vertebrae). | **[[Spinal cord compression]] and [[paraplegia]] ([[paralysis]] of the lower half of the [[body]] with involvement of both [[legs]]) develop when the [[tumor]] extends into the [[intervertebral foramina]] (opening between two [[vertebrae]]). | ||
'''Surgical Complications''' | '''Surgical Complications''' | ||
* [[Bronchopleural fistula]] | * [[Bronchopleural fistula]] | ||
:* It is when air leaks from a [[pneumonectomy]] bronchial stump | :* It is when air leaks from a [[pneumonectomy]] [[bronchial]] stump. | ||
:* | :* Experienced in approximately 2% of patients that undergo a [[pneumonectomy]]. | ||
:* It | :* It commonly occurs approximately 7 to 10 days after [[surgery]]. | ||
* [[Hemothorax]] | * [[Hemothorax]] | ||
:* In | :* In majority of cases, it occurs from [[bronchial vessels]] or [[lung]] [[parenchyma]]. | ||
:* It may have the [[symptoms]] of [[hypovolemia]] | :* It may have the [[symptoms]] of [[hypovolemia]]. | ||
:* Usually, it can be treated by [[transfusion]] | :* Usually, it can be treated by [[transfusion]]. | ||
* [[Atelectasis]] | * [[Atelectasis]] | ||
* [[Sputum]] retention | * [[Sputum]] retention | ||
*Wound infection | *[[Wound]] [[infection]] | ||
*Wound dehiscence | *[[Wound]] [[dehiscence]] | ||
*Air embolism | *[[Air embolism]] | ||
*Respiratory failure associated with or without ARDS | *[[Respiratory failure]] associated with or without [[Acute respiratory distress syndrome|ARDS]] | ||
'''Vascular complications''' | '''Vascular complications''' | ||
*Subclavian artery injury | *[[Subclavian artery|Subclavian artery injury]] | ||
*Subclavian vein thrombosis | *[[Subclavian vein thrombosis]] | ||
*Forearm edema | *[[Forearm]] [[edema]] | ||
*Chylothorax | *[[Chylothorax]] | ||
'''Neurological complications''' | '''Neurological complications''' | ||
*Klumpke-Déjérine syndrome | *Klumpke-Déjérine syndrome | ||
*Horner’s syndrome (miosis, ptosis, and enophthalmos) | *[[Horner's Syndrome|Horner’s syndrome]] ([[miosis]], [[ptosis]], and [[enophthalmos]]) | ||
'''Chemo-radiotherapy complications''' | '''Chemo-radiotherapy complications''' | ||
*Pneumonitis | *[[Pneumonitis]] | ||
*Peripheral neurologic dysfunctions | *[[Neurological disease|Peripheral neurologic dysfunctions]] | ||
*Esophagitis | *[[Esophagitis]] | ||
*Infection | *[[Infection]] | ||
*Hematologic toxicity | *[[Hematologic]] [[toxicity]] | ||
*Stomatitis | *[[Stomatitis]] | ||
==Prognosis== | ==Prognosis== | ||
*The prognosis of Pancoast tumor depends on the stage of the tumor at diagnosis.<ref name="pmid10974447">{{cite journal |vauthors=Komaki R, Roth JA, Walsh GL, Putnam JB, Vaporciyan A, Lee JS, Fossella FV, Chasen M, Delclos ME, Cox JD |title=Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=48 |issue=2 |pages=347–54 |date=September 2000 |pmid=10974447 |doi= |url= |author=}}</ref><ref name="pmid8010786">{{cite journal |vauthors=Ginsberg RJ, Martini N, Zaman M, Armstrong JG, Bains MS, Burt ME, McCormack PM, Rusch VW, Harrison LB |title=Influence of surgical resection and brachytherapy in the management of superior sulcus tumor |journal=Ann. Thorac. Surg. |volume=57 |issue=6 |pages=1440–5 |date=June 1994 |pmid=8010786 |doi= |url= |author=}}</ref><ref name="pmid9189936">{{cite journal |vauthors=Johnson DE, Goldberg M |title=Management of carcinoma of the superior pulmonary sulcus |journal=Oncology (Williston Park, N.Y.) |volume=11 |issue=6 |pages=781–5; discussion 785–6 |date=June 1997 |pmid=9189936 |doi= |url= |author=}}</ref> | *The [[prognosis]] of Pancoast tumor depends on the stage of the [[tumor]] at [[diagnosis]].<ref name="pmid10974447">{{cite journal |vauthors=Komaki R, Roth JA, Walsh GL, Putnam JB, Vaporciyan A, Lee JS, Fossella FV, Chasen M, Delclos ME, Cox JD |title=Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=48 |issue=2 |pages=347–54 |date=September 2000 |pmid=10974447 |doi= |url= |author=}}</ref><ref name="pmid8010786">{{cite journal |vauthors=Ginsberg RJ, Martini N, Zaman M, Armstrong JG, Bains MS, Burt ME, McCormack PM, Rusch VW, Harrison LB |title=Influence of surgical resection and brachytherapy in the management of superior sulcus tumor |journal=Ann. Thorac. Surg. |volume=57 |issue=6 |pages=1440–5 |date=June 1994 |pmid=8010786 |doi= |url= |author=}}</ref><ref name="pmid9189936">{{cite journal |vauthors=Johnson DE, Goldberg M |title=Management of carcinoma of the superior pulmonary sulcus |journal=Oncology (Williston Park, N.Y.) |volume=11 |issue=6 |pages=781–5; discussion 785–6 |date=June 1997 |pmid=9189936 |doi= |url= |author=}}</ref> | ||
*The presence of the following is associated with a poor prognosis among patients with Pancoast tumor : | *The presence of the following is associated with a poor [[prognosis]] among [[patients]] with Pancoast tumor: | ||
**Horner syndrome | **[[Horner's syndrome]] | ||
**Spread to the mediastinal lymph nodes | **Spread to the [[mediastinal lymph nodes]] | ||
**Incomplete resection of tumor | **Incomplete resection of [[tumor]] | ||
**Involvement of supraclavicular lymph node | **Involvement of [[supraclavicular lymph node]] | ||
**Vertebral body invasion | **[[Vertebral body]] [[invasion]] | ||
**Metastasis to the brain | **[[Metastasis]] to the [[brain]] | ||
*Pancoast tumor is associated with a 5 survival rate as follows depending on the stage of disease: | *Pancoast tumor is associated with a [[Survival rates|5 year survival rate]] as follows depending on the [[Disease|stage of disease]]: | ||
{| class="wikitable" | {| class="wikitable" | ||
!Stage Of Pancoast Tumor | !Stage Of Pancoast Tumor | ||
Latest revision as of 17:48, 15 March 2018
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Risk calculators and risk factors for Pancoast tumor natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]
Overview
The patient experiences non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, dysphonia, dysphagia, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention. Without treatment, the patient will develop initial symptoms of cough and chest pain, which may eventually lead to Pancoast's syndrome. The symptoms of Pancoast's syndrome start as referred pain to the shoulder. Without treatment, the tumor may invade surrounding tissues to cause pain along the ulnar nerve distribution, atrophy of hand muscles and spinal cord compression. The complications associated with Pancoast tumor are breathing difficulties, pneumonia, hemoptysis, pain, pleural effusion,metastasis, Horner's syndrome, superior vena cava syndrome, compression of the spinal cord, and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between two vertebrae). The prognosis of Pancoast tumor depends on the stage of the tumor at diagnosis. The factors associated with a poor prognosis among patients with Pancoast tumor include Horner's syndrome, spread to the mediastinal lymph nodes, incomplete resection of tumor, involvement of supraclavicular lymph node, vertebral body invasion, metastasis to the brain.
Natural History
- The patient experiences non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, dysphonia, dysphagia, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention.[1][2][3]
- Without treatment, the patient will develop initial symptoms of cough and chest pain, which may eventually lead to Pancoast's syndrome.
- The symptoms of Pancoast's syndrome start as referred pain to the shoulder. Without treatment, the tumor may invade surrounding tissues to cause pain along the ulnar nerve distribution, atrophy of hand muscles, and spinal cord compression.
Complications
Pancoast tumor is a subtype of lung cancer that is located at the apex of the lung.The complications associated with Pancoast tumor are:[1][2][3][4][5]
- If cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia.
- It is possible that Pancoast tumor will cause shoulder pain as well, especially if it spreads to the surrounding tissue resulting in Pancoast's syndrome.
- Lung cancer can cause fluid to build up in the lungs which can cause breathing difficulties.
- In many cases, lung cancer will spread out to other parts of the body. Some of the more common places lung cancer metastasizes to are the bones, liver, brain, and adrenal glands.
- Tumors in the apex of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner's syndrome).
- Superior vena cava syndrome
- SVCS is a group of symptoms caused by obstruction of the superior vena cava. More than 60% of cases of superior vena cava obstruction are caused by malignant causes, typically a tumor outside the vessel compressing the vessel wall.
- Compression of the spinal cord
- Spinal cord compression and paraplegia (paralysis of the lower half of the body with involvement of both legs) develop when the tumor extends into the intervertebral foramina (opening between two vertebrae).
Surgical Complications
- It is when air leaks from a pneumonectomy bronchial stump.
- Experienced in approximately 2% of patients that undergo a pneumonectomy.
- It commonly occurs approximately 7 to 10 days after surgery.
- In majority of cases, it occurs from bronchial vessels or lung parenchyma.
- It may have the symptoms of hypovolemia.
- Usually, it can be treated by transfusion.
- Atelectasis
- Sputum retention
- Wound infection
- Wound dehiscence
- Air embolism
- Respiratory failure associated with or without ARDS
Vascular complications
Neurological complications
- Klumpke-Déjérine syndrome
- Horner’s syndrome (miosis, ptosis, and enophthalmos)
Chemo-radiotherapy complications
- Pneumonitis
- Peripheral neurologic dysfunctions
- Esophagitis
- Infection
- Hematologic toxicity
- Stomatitis
Prognosis
- The prognosis of Pancoast tumor depends on the stage of the tumor at diagnosis.[6][7][8]
- The presence of the following is associated with a poor prognosis among patients with Pancoast tumor:
- Horner's syndrome
- Spread to the mediastinal lymph nodes
- Incomplete resection of tumor
- Involvement of supraclavicular lymph node
- Vertebral body invasion
- Metastasis to the brain
- Pancoast tumor is associated with a 5 year survival rate as follows depending on the stage of disease:
| Stage Of Pancoast Tumor | 5 year survival rate |
|---|---|
| IIB | 47% |
| IIIA | 14% |
| IIIB | 16% |
References
- ↑ 1.0 1.1 Glassman LR, Hyman K (July 2013). "Pancoast tumor: a modern perspective on an old problem". Curr Opin Pulm Med. 19 (4): 340–3. doi:10.1097/MCP.0b013e3283621b31. PMID 23702478.
- ↑ 2.0 2.1 Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D (March 2014). "Pancoast tumors: characteristics and preoperative assessment". J Thorac Dis. 6 Suppl 1: S108–15. doi:10.3978/j.issn.2072-1439.2013.12.29. PMC 3966151. PMID 24672686.
- ↑ 3.0 3.1 Jones DR, Detterbeck FC (July 1998). "Pancoast tumors of the lung". Curr Opin Pulm Med. 4 (4): 191–7. PMID 10813231.
- ↑ Jones, DR (Jul 1998). "Pancoast tumors of the lung". Current Opinion in Pulmonary Medicine. 4 (4): 191–197. PMID 10813231. Unknown parameter
|coauthors=ignored (help) - ↑ Eren S, Karaman A, Okur A (2006). "The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT". Eur J Radiol. 59 (1): 93–103. doi:10.1016/j.ejrad.2006.01.003. PMID 16476534.
- ↑ Komaki R, Roth JA, Walsh GL, Putnam JB, Vaporciyan A, Lee JS, Fossella FV, Chasen M, Delclos ME, Cox JD (September 2000). "Outcome predictors for 143 patients with superior sulcus tumors treated by multidisciplinary approach at the University of Texas M. D. Anderson Cancer Center". Int. J. Radiat. Oncol. Biol. Phys. 48 (2): 347–54. PMID 10974447.
- ↑ Ginsberg RJ, Martini N, Zaman M, Armstrong JG, Bains MS, Burt ME, McCormack PM, Rusch VW, Harrison LB (June 1994). "Influence of surgical resection and brachytherapy in the management of superior sulcus tumor". Ann. Thorac. Surg. 57 (6): 1440–5. PMID 8010786.
- ↑ Johnson DE, Goldberg M (June 1997). "Management of carcinoma of the superior pulmonary sulcus". Oncology (Williston Park, N.Y.). 11 (6): 781–5, discussion 785–6. PMID 9189936.